Secondary infections in coronavirus disease (COVID)-19 pneumonia in association with lung cavitation are rare findings. The development of cavitation has been attributed to aseptic liquefaction of pulmonary thromboemboli or secondary infection, resulting in the formation of pneumatoceles. Rupture of a large pneumatocele may lead to the development of pneumothorax. We report the case of a 56-year-old male who was treated for COVID-19 pneumonia with severe acute respiratory distress syndrome (ARDS) but developed pneumothorax and a cavitary lesion in the recovery period. This was further complicated by a co-infection with Aspergillus fumigatus in endotracheal secretions. The pneumothorax failed to resolve and there was a failure to wean off mechanical ventilation, culminating in death after 2 weeks. This case report highlights the need to monitor for small pneumatoceles even in the recovery phase of COVID-19 which may predispose to pneumothorax or pneumomediastinum.

Quad fever is a rare and sometimes fatal condition characterised by sustained high temperatures of 40.8° C (105.4° F) and above, in spinal cord injury patients. Patients are often unresponsive to routine antipyretics and diagnosis is usually one of exclusion after other causes of fever are ruled out. This condition is understood to be secondary to autonomic dysfunction leading to thermoregulatory impairment. In the present case report, a 53-year-old male patient developed a fever of 104°F two days after a traumatic spinal cord injury involving C6-C7 segments. The fever did not respond to paracetamol, empirical broad-spectrum antibiotics or thromboprophylaxis. After ruling out both infectious and non infectious causes of fever, the hyperthermia was attributed to quad fever, a type of neurogenic fever. The patient continued to have non relapsing high fever and died five days after presentation. The case highlights the need to be aware of this differential in cases of high fever following traumatic spinal cord injury, in order to better prognosticate and also avoid unnecessary antimicrobial usage.